AZCEP

A bougie is simply a device to allow placement into a body cavity. For this situation, it is a flexible stylette. They are roughly 2-3 times longer than a standard stylette, and are easier to manipulate into the glottic opening than the larger ET tube.

The pictures really don't do the differences justice. Single lumen, dual cuffs. No latex. Much shorter, less cumbersome than the Combitube. Easily the best thing about this device is the "ramp" at the distal end that directs ventilations into the glottis. It is this feature that allows for the use of a bougie to go into the trachea for ET placement. It is a much better option than the Combitube on the basis of design. I've not had a chance to actually use it yet, however.

Can't tell from the photos, and he did not get burned enough regardless.

Your instructor should spend more time instructing and less time criticizing then. Ask them to teach you how to properly write the report.

Fentanyl is a much better option, but Morphine definitely has it's place. Having a choice, I'd want the Fentanyl, unless having both was an option. The short duration of Fentanyl can make it difficult to maintain analgesia.

At worst you may have wasted some electrodes by placing more of them when you didn't really need to. At best you would have found something that was not showing up in the leads you had. I don't see any reason to look at the right side leads, but to say you were wrong in looking isn't real professional either. You looked for more information and didn't find it. You wouldn't have known that if you hadn't looked in the first place.

A usable restraint system for the providers. Many have tried to develop something that will work, and it always becomes cumbersome to actually use. Equipment within arms reach. The major problem is having people wander all over the patient compartment to find the item that they need to use. Involve OSHA in the regulation of ambulance operations. Right now ambulance safety is a "transportation issue", so the D.O.T is held responsible. D.O.T. only legislates safety measures within two feet of the back of the driver's seat, which leaves most of the patient compartment uncovered.

Current ambulance design is a tragedy waiting to happen. Partially due to no one entity being responsible, and the end user being willing to accept the design limitations coming from manufacturers. Ambulance design is unsafe, and it is extremely expensive to modify the design to improve safety. Unfortunately, those responsible are subsidised by the industry to leave well enough alone. You may hear of a few individual modifications to improve the situation, but there will never be widespread changes made. It's just too costly to do so. Both to the consumer, and the manufacturer.

Per the Manual of Emergency Airway Management: 1) Failure to protect the airway 2) Failure to adequately ventilate 3) Anticipated clinical course Much better to intubate early, than to wait until you absolutely have to, only to find that you can't due to underlying pathology.

It's not so much a need for an accessory, but more to show someone later what you actually heard. Similar to using camera phones to document vehicle accidents, or injuries before you cover them up. It becomes a matter of gathering information to show why you do something. Technologically enhanced CYA, perhaps.

If the MP3 is being considered it will only be a matter of time until the stethescope manufacturers will build it into their devices. The electronic stethescopes can record the sound when connected to an outside device, which tends to make them a bit ungainly for normal use. Having the option of playback would be extremely useful for some of the more subtle things that we might miss. Being able to reproduce what you heard for someone else later might help justify treatments as well.

I'm betting that you were never supposed to get a 5 lead cable. It's a pretty easy ordering SNAFU, but doesn't really grant a whole lot more in the grand scheme of things. You have the standard four leads to gain the 6 limb leads (I,II,III,aVR, aVL, and aVF) then you add a chest lead to pick up whichever view you are after. Commonly, the chest lead will view V1 or V2. This way you will usually get a better view of the atrial activity, and some specific ECG events that don't show as well in anterior, or lateral leads. For all intents and purposes, you could put the chest lead pretty much anywhere on the patient that you wanted to, since you probably won't use it for rhythm identification very often anyway.

http://us.elsevierhealth.com/product.jsp?isbn=9780323035071 for a pathophysiology text that you have to have. If you want something that will give you the information that you need http://22e.cecilmedicine.com/buy.cfm?book=goldman if you are looking for something that won't "talk down to you", don't bother with it.

On more than one occasion, I've told the receiving physicians that they can confirm MY tube placement with MY capnography only to turn them over, get a signature, then have them rely on lesser equipment. Pretty comical.

Did this Basic/Basic crew give the Lasix? With a hypotensive patient? Something is being lost in the translation of this one. No, the use of "shock position" is not included in our protocols. We are covered by the more general "treat for shock".

Which is precisely why it will never be the standard of care. Too many places that don't excel in the listed areas.

Unfortunately, too many don't consider nasal intubation at all. RSI has killed it off in those places that have been so blessed. I've rescued myself with a nasal tube several times when an oral attempt went bad. We don't have RSI available until an aircraft arrives, unless you count the home version. :wink:

Have someone else hold manual in-line position, and remember that you are only trying to move the tongue out of the way. If you are lifting the head off the table, you are working too hard. A lighted stylette is a great idea, if not very common. The bougie will also make things much easier. Nasal intubation is not very useful in the crash airway situation. What will kill the patient first? Lack of an airway, or a secondary SCI?

Medscape recently had an article about using therapeutic hypothermia for hemorraghic shock, but I can't seem to find it. It seems that induced hypothermia is the next "magic bullet" in healthcare. Many are studying if it will benefit a wide range of patient situations. http://www.medscape.com/viewarticle/405605

There's still plenty of room on the Diamondbacks bandwagon if you're interested.

Torre or not the Yankees are going to fall apart next season anyway. Most of the big names are looking to move on. Seems that Jeter/Matsui/Giambi will be the only ones back. No other coach/manager would be given as much leeway as Torre has been. I think he will be gone.

The EMT-I could very easily be done away with, as it has outlived it's usefulness. Many EMT-B programs are introducing more and more advanced skills all the time. Holding on to the intermediate wastes resources. I will agree with vs-eh's suggestion of allowing the entry level provider to gain some autonomous experience, with the caveat that it is unusual for EMT-Bs to be used in systems where they will gain useful experience in a reasonable amount of time. Having the experience prior to enrolling in a paramedic class can be useful, but it can make advancing more difficult as well.

Skeletal muscle is just like any other contractile tissue. It will generate an action potential, the electrolytes will move into, then out of the cell as it needs them to. Calcium is needed for muscle contraction. When a tissue becomes acidotic, the intracellular potassium is drawn out, forcing sodium and calcium in. This can also occur with a hypocalcemic state if we remember that the value is determined from the ECF.

Could the cost issues be due to insurance companies not wanting to include Zofran in their formulary? This is the message we've gotten several times as to why we do not have the option.

Tracheal intubation has not shown to be particularly valuable for managing trauma, medical, pediatrics, or cardiac arrest situations. By itself, it will not improve anything. Combined with the inability of most to correctly ventilate once the airway is secured, you quickly run into good reason to disallow the procedure. Gold standard or not, when providers don't perform enough to remain competent in the procedure, there is no reason to allow everyone to use it. Especially when rescue devices are just as effective for the short term, and are placed before the airway is full of fluid/foreign bodies that poor intubation technique introduce.